Health alert
- Status:
- Active
- Alert number:
- 240314
- Date issued:
- 13 Mar 2024
- Issued by:
- Professor Ben Cowie, Chief Health Officer
- Issued to:
- Health professionals and the Victorian community
Key messages
- There has been a Shigella gastroenteritis outbreak among people at the Esoteric festival. Additional patrons and staff who are returning to locations within Victoria and inter-state may develop symptoms in the coming days.
- People who attended Esoteric Festival who have symptoms should get tested for Shigella with a stool sample.
- Symptoms may include diarrhoea, abdominal cramps, nausea and vomiting.
- Shigella gastroenteritis is generally a self-limiting infection but is highly contagious and can be potentially serious.
- People with shigellosis who work as food handlers, childcare workers, health care workers, or workers in a residential facility should not return to work until advised.
- People with Shigella gastroenteritis symptoms should maintain good hygiene, practice handwashing, avoid preparing food for others and practice safer sex practices.
- Clinicians should include stool culture when testing patients for shigellosis.
- Antibiotic treatment should only be used for severe infection.
- Preliminary results suggest an antimicrobial resistant strain of Shigella, therefore standard empirical therapies for Shigella may not provide appropriate coverage in cases linked to this outbreak.
What is the issue?
There has been a gastroenteritis outbreak among staff and patrons at the Esoteric Festival held in Donald, Buloke from 8 to 12 March 2024. Initial investigation identified Shigella bacteria as the likely cause of the outbreak. Loddon Mallee Public Health Unit has been working with the Department of Health, Buloke Shire Council, local health staff, festival management, and other stakeholders to ensure appropriate measures were put in place to prevent further spread.
Who is at risk?
There is a risk of additional Esoteric Festival patrons and staff who are returning to locations within Victoria and inter-state developing Shigella gastroenteritis symptoms in the coming days.
Symptoms and transmission
Shigella gastroenteritis (shigellosis) is a bowel infection characterised by an acute onset of diarrhoea (which may be watery or contain traces of pus, mucous or blood), fever, nausea, vomiting and abdominal cramps. It is usually a self-limiting infection, however severe illness and complications can occur in certain at-risk individuals, such as young children, older people and those who are immunocompromised.
Shigella gastroenteritis is highly contagious and is mainly transmitted through the faecal-oral route, or contaminated food. It may also be transmitted during sexual contact, especially oral sex and oro-anal sex. Symptoms usually develop one to three days following exposure but can occur as early as 12 hours to as late as one week afterwards in some cases.
People are infectious while the Shigella bacteria continue to be shed in faeces. This can last for up to four weeks after symptoms resolve.
Treatment
Treatment includes plenty of fluids and oral rehydration drinks. Antibiotic treatment may be required for cases of severe infection.
Recommendations
Attendees of Esoteric Festival
- Seek medical care if you develop symptoms. Shigella gastroenteritis can be diagnosed with a stool sample.
- If you have gastroenteritis symptoms, do not prepare food or provide personal care for others until 48 hours after symptoms resolve and practice safer sex practices.
- It is very important that people with Shigellosis who work as food handlers, childcare workers, healthcare workers, and people who work in a residential facility such as aged care facilities, disability group homes, prisons, and other residential facilities get tested and diagnosed and provided advice about when it is safe to return to work by their Local Public Health Unit.
- Good hygiene can prevent the spread of Shigella gastroenteritis. Wash your hands often and thoroughly, especially after using the toilet and before eating or preparing food.
- People who have been diagnosed with Shigella gastroenteritis should abstain from sex while symptomatic and for two weeks after symptoms completely resolve. For a further week use barrier protection (such as condoms and dams) during sex. Shower and wash hands before and after sex.
For clinicians
- Clinicians should have a high suspicion for shigellosis in anyone with compatible symptoms who attended Esoteric Festival.
- Request a stool culture and PCR when investigating for shigellosis.
- Antibiotic treatment should be reserved for cases of severe infection or those who are immunocompromised.
- Antibiotic choice should be based on susceptibilities and advice should be sought from an infectious disease specialist or microbiologist as antibiotic resistance varies by region and over time.
- Given the suspected resistance profile, severely unwell cases of Shigellosis who attended the Esoteric Festival should be treated empirically with meropenem.
- Those with Shigella who work as food handlers, childcare workers, healthcare workers, and people who work in a residential facility such as aged care facilities, disability group homes, prisons, and other residential facilities should not return to work until advised it is safe by their Local Public Health Unit.
- Patients should be advised to maintain good hygiene and safer sex practices, avoid preparing food for others and be excluded from work if required until cleared by their Local Public Health Unit.
- Clinicians and pathology services must notify the Department of Health of any cases of shigellosis within five days of diagnosis. Notifications can be made or faxed on 1300 651 170.
Reviewed 14 March 2024